Intramedullary splint



g- 1950 J. T. KANE INTRAMEDULLARY SPLINT Filed Nov. 29, 1946 INVENTORFIG. 4

FIG 5 JOHN T. KANE B%(MJW ATTO R N EY Patented Aug. 8, 1950 -isrAr-nsPATENT- 1= I f 2,318,019 v I I I WTB MEDULLARY SPLINT T r o ir-;Binghamtdirjn. Y.

" I Atr iicatio'n November 29, i946, Serial No. 712,915 .01551 c 2 V My-inventiim relates oi'an improvedintrm medullary splint for use inthetreatment of fractured limbs, and it will be described herein'as' it ispreferably made-andused by me in the care of T patients suffering from;a diaphyseal fracture or fractures of'the femur. i J I *f-';Intra'r'ne'dullary splints; 'of a U or V sha'pe in cros'sfsection havebeenused'for a considerable length-0f time in the "care of patientssuffering from fractures, including fractures or the femur, Such splintshave had, general; several dis advantageous features' orcharacteristics. 1 For example, thepreviously used splints have; beenstraight lengthwise, and have not beenshaped complementaryj ftheanteroposterior and lateral bowing ofthe'medullary cavityfin the mannerrequired to give the 'niaxii'r vgrri amount vof support-to" thefractured bone" at the fracture site. 'Also', the same failure to shapethe splint in: accordance f with the" anteroposte'rior. andf'lat eral vbowing of the medullary cavity; has ,made it extremely fdifiicult forthe attending surgeon in some cases to be certain that the fracturedbone fragments are properly aligned, and in such cases misalignment'has'frequently resulted, with all; of its attendant 1 serious fcolfieqliences. Further'; because" of the' 'f lure 'tol shape 'suclfsplints complementary to the, owing of themedullary cavity, it has beenimpossible to insert the splints in the'lower third offthe' mediillarycavity to make suchsplints'of usejin the treatment of fractures in 'thelower third of theifemuru In the in'sertion of "the prior art, 'straightsplints, frequent driving of the, lower end,of,..the fsp1int into theboneihas occurred/.51

' Another seriouslldisfadvaritage of the previously knownintramedull'a'ry splints is that they have not'sufficiently filled thecavity, thus permitting relative movements between the fractured bonesegments themselves, aswell as'relative movements between, the.fractured bone segments and thesplint, In the case of the firstmentioned relative movements, union-of the bone fragments is prolonged,and .the,fragments do not necessarily in proper aligmn nt and position.In thefcase of relative movements betweenthe' bone fragments and thesplint, the splint may retain the displaced bone fragments I :in animproper position, thereby. promoting union-of the bone fragments amisaligned position.

still another undesirable, feature of the prior artintramedullary,splints is thatthey have not gripped the bone fragments with sufiicientcerlelntm Prevent, ,lateralrotation. er..-the: 1m-

ments, resulting; in delayed and ,improperly aligned union.

Also, the U -shaped splints knownto the prior art have an additionaldisadvantageous feature in that a large area of the splint contactstthewall, of the cavity, cutting 01f minimal circulalion inthe-area ofcontact.

The general object of my invention is to provide an .intramedullarysplint. which; does not have the outlined disadvantages of thepreviously known intramedullary splints, and which will, use, facilitatethe locating of the bone frag mentsjby the attending surgeon in theirproper positions, in all respects, and which will hold the bonefragments in such position until "unmn is completed'and the splint iswithdrawn. I Another object of my invention is to provide a simplyconstructed, easily insertable and easily removable intramedullarysplint which'will' not irritate the body in any manner while insertedtherein.

' Qther objects and advantages of my invention will become apparent upona reading ofthe folglowing disclosure. g

I 5 In order that the preferred embodiment of my invention may beclearly understood, reference is made-to the accompanying drawing,showing a preferred embodiment thereof, whereinf Fig.-1 is-a partialcross-sectional anterior view of the femur of the left leg, showing theimproved inserted in the medullary cavity thereof. p

Fig. 2 is a partial cross-sectional lateral view of the'same elements asshown in Fig.1,- as seen from the left side of the femur. a Fig. 3 is asectional view, taken along the plane III -III- of Fig. 2. p Y Fig 4 isa sectional view, taken alongthe plane IV--IV of Fig. 2, and I Fig; 5 isa sectional view, taken along the plane v' v of Fig. 2. Referring now toFig. 1, the left "femur is shaped, as seen anteriorly, as shown, thefemur being numbered ID. A fracture is designated ll. The head of thefemur l2 and condylar region 14 are shown, as is the medullary cavitywhich is designated Hi; It will be noted that this cavity extends fromthe area of the insertion of inferior gemelli muscles [8 to thesupra-condyle 20, near the lower end thereof. As shown in the anteriorview, the medullary cavity I6 is slightly bo'wed, the upper and lowerends being displaced'outwardly or to the right, of the centralpor'tio'nof the cavity; Further, the cavity tapersfrom "alarger-diameter at the top thereof to a; smaller diameter aboutone-third of the distance down the femur; the cavity then maintains afairly constant diameter during the middle third of its extension; andthen the cavity gradually increases in diameter for the remaining thirdof its extension.

Referring now to Fig. 2, the left femur is shaped, as seen from the leftside thereof, as shown in outline. The head of the femur l2 and condylarregion [4- are shown; as is themedullary cavity [5. The anteroposteriorbowing of the cavity will be seen to be greater than the. lateral bowingwhich was previously described in" In Fig. 2 itlwill -be. seen that theupper and lower ends of the cavity are,

connection with Fig. 1.

located posteriorly of the middle portion thereof. Insofar as the sizeof the. cavity-is concerned, when seen as viewed in Fig. 2, thecavitytapers from a larger diameter. at the top thereof to a smallerdiameter aboutone-third of the distance down the femur; the cavity thenmaintains a fairly constant diameter during themiddle third of itsextension; and then the cavity gradually increases in diameter in thelower third of its extension. I

Referring again to Fig. 1, there isshown inserted in the medullarycavity l-S a'splint made in accordance with the principles of myinvention. This splint includes an elongated main body 22, a lowerpointed end '24, a pin 26 affixed to the upper end of the elongated body22, and a ball 28 affixed to the upper end of this pin. In Fig. 4 itwill be seen that'the'body portion 22 ofthe splint is four-sidedandgen'erally' square in cross section, and is preferably of tubularmetal construction, to impart strength as well as lightness thereto. Tothelower end of thembular body portion is aflixed a plug 24, also preferably four-sided, to conform to t emes of the main body portion. Thelowermost end of this plug is preferably pointed, as shown, and thisplug may be aflixedto the main body portion in any suitable manner, ormay be formed integrally therewith. 7

At the upper end of the body portion .22, as seen in Fig. 3,-is providedtheplug 39, whichmay be affixed to the body 22 in any suitable method,or may be formed integrally therewith. Carried by plug is the pin 26 towhich is affixed the metalball 28. v v

Referring now to Figs. 1 and 2, itwill .be seen in both views that theelongated body portion 22 is of greater width at the top and tapersgradually throughout the upper third of its. extension, and-is. more orless constant. in Width throughout its lower two-thirds of length, Ifdesired, however, thelower third of the splint maybe tapered to a lesserwidth than the middle thirdthereof. The width of the splint at any.placein' the approximate upper tWo-thirds thereof issuch' that when thesplint is driven into place,;=;as., shown inFigs. l and 2, the fourcornersv of thesplint will firmly engage the inner wallof the bone whichforms the medullary cavity.

n Fig. 1 a will be seen that the body 221s slightly bowed, its upper andlower ends being displaced outwardly or to the right, of the centralportion thereof. Accordingly, the splint22 is bowed mediallycomplementary to the medial bowing of the medullary cavity... In Fig. 2,the anterior bowing of the splint is more accentuated thanthe medialbo-wingin Fig. l, and-wis bowed complementary to the anterior bowing-ofthe ;f'orej the operation. The affected extremity is adduct'ed and"internally rotated. If a method of traction is available for use on theaffected I limb, such a procedure should be exercised.

vertically, thehip joint may be readily exposed.

The gluteus maximus muscle is divided, and the gluteus medius muscle isincised at the point of its insertion. The finger may then be introducedinto the niche which is'foccupied by the inferior gemelli muscles;anda-l/z" drill hole; may be made at this site, and the marrow cavityreadily exposed... Atthe'sa-me time, arr incision is made over thefracture site and the-fragments. are approximated using ja bone clamp tohold them together. By means of aqhammer the splint is driyen into themarrow cavity and across the fracture ,site to the' position shown inthe drawings..- The wound is. then closed at both the fracture site, andat the point of introduction of the. splint... The g-luteus medius. isre-sutured at the pointof insertion; the gluteus maximus isapproximated,:and the.- skin is closed with silk. .The open method ,ofoperation allows the surgeonto place the splintin an extra capsularpositifon,.thus.avo iding. the introduction of infection into thehipjoint. proper.

The splint. mayberemovedafter the bone fragments have. sufficiently.unitedthrough an in icision ov'er,theItuberosity on the affected side.Lubrication-"of the 'medullary cavity. will facilitate extraction.'Theprovision of the ball 28, which may be. grasped by asnitableinstrument, 'a'ssuresfleasy removallof' the splint.

By virtue of the compound bowing of the splint, as well asthefclescribe'd tapering thereof, i'tjwill be appreciated that thesplint. of this invention establishe a proper. reference withres'pect'to'wh'ich thebqne fragments may he properly'approximatfedby'the'attending surgeon, so that perfect apposition ofthefragments may be had. ,"The square, tapered"spl'i11t assures en-'gag'ement ofthe splintfat each of itsv four corners forat'jlfea'stftwo-tl' irds the length of the splint witl'tthe interior ofthe bone fragments.

The bone fragments are held in proper position, thus'preventing'latera'hrotation of the frag- Liateral -rotatiom-is most apt tooccur inthe case of fractures in the upper two-thirds" of'the femur and-resultsfromthe action of the iliopsoas' muscles arid external rotators of thehip tend to turnthenpper bonefragment when the-*patient is walking.Clearly; by the use of my splintthe upper and lowerfragm'ents areheldiii-position relativeto' one another toprevent any relative l'ateralr 'otation between the upper and lower fragmentsr :In thecase-offractures of the lower third ofthef'em ur; the -musc-lesinserting at the lower end of the femur-tend topull the lower fragmentposteriorlywith resultant anterior displacement 'of the upperfi'agmentresulting in the formation of en angle-between the twofragments. Also,

medullary cavitylfi. .It will be notedthat the w theends of the benefragments may slidepast one 5. another. In either case, shortening ofthe bone and leg results. By the provision of a splint bowedcomplementary to the medial and anteroposterior bowing of the medialcavity, it is possible to drive the lower end of the splint into thelower end of the cavity, thus minimizing the danger of suchdisplacements.

The main body portion of the splint is preferably completely within themedullary cavity, and

the pin 26 and ball 28 are the only portions of the splint outside thecavity. By virtue of this arrangement the corners of the splint grip thebone fragments to hold them in proper juxtaposition, and the smoothsurfaces of the pin 26 and ball 28 will not irritate the muscles of thepatient nor the neighboring joint capsule, thus diminishin greatly thedangers of infection in the hip joint and surrounding muscles.

The completely enclosed splint prevents secretions from the body leakinginto the splint, and the plating of the splint with vitalium or tantalumprevents any corrosion of the splint, or resulting infection. Becausethe splint engages the interior of the bone only along the four edges ofthe splint, minimal circulation is permitted through most of the area ofthe cavitywall.

Not only does the use of my splint assure the retention of the bonefragments in proper position while union is taking place, but theretention of the fragments in such position, in continuous contact withthe adjoining fragment or fragments greatly facilitates early union ofthe fragments. Earlier ambulation of the patient is possible, not onlyresulting in a psychological uplift to the patient, but also lesseningthe danger of complications, such as hypostatic pneumonia,

urinary infection, urinary calculi, etc., resulting fromkeeping thepatient in bed for a longer period of time. Physiotherapy may be begunat an earlier time, and muscular atrophy will be minim'al. Also, earliermassage and ambulation will prevent stiffness of the knee on theaffected side.

Certain of the improved features of my invention may be utilized in theconstruction of other types of splints. Also, it will be appreciated bythose skilled in the art that changes may be made in the disclosedpreferred embodiment of my invention without parting from the substancethereof. All such uses and changes are intended to be covered by thefollowing claims.

I claim:

1. An intramedullary splint for use in the treatment of fractures of thefemur comprising an elongated member bowed medially andanteroposteriorly corresponding to the medial and'antero-posteriorbowing of the medullary cavity of the femur, the upper end portion ofsaid splint being tapered from a greater size at the upper end thereoffor a substantial portion of the length of the same, and the adjoiningportion of said splint being of substantially constant width for asubstantial portion of the length thereof.

2. An intramedullary splint for use in the treatment of fractures of thefemur comprisin an elongated member bowed medially and anteroposteriorlycorresponding to the medial and antero-posterior bowing of the medullarycavity of the femur, the upper end portion of said splint being taperedfrom a greater size at the upper end thereof for a substantial portionof the length of the same and the adjoining portion of said splint beingof substantially constant width for a substantial portion thereof, theoutermost portions of said member comprising a plurality of generallyparallel, relatively narrow and circumferentially displaced surfaces forgripping the walls of the medullary cavity.

3. An intramedullary splint for use in the treatment of fractures of thefemur comprising an elongated four-sided tubular member substantiallysquare in cross-section, a pointed plug held by the lower end of saidmember, a plug in the upper end of said member, a pin held by the lastmentioned plug, and a ball held by the upper 3 end of said pin, the saidelongated member being bowed medially and antero-posteriorlycorresponding to the medial and antero-posterior bowing of the medullarycavity of the femur.

4. An intramedullary splint for use in the treatment of fractures of thefemur comprising an elongated four-sided tubular member substantiallysquare in cross section and tapered from a greater size at the upper endthereof for a substantial portion of the length of the same, a pointedplug held by the lower end of said member, a plug in the upper end ofsaid member, a pin held by the last mentioned plug, and a ball held bythe upper end of said pin, the said elongated member being bowedmedially and antero-posteriorly corresponding to the medial andantero-posterior bowing of the medullary cavity of the femur.

5. An intramedullary splint for use in the treatment of fractures of thefemur comprising an elongated tubular member bowed medially andantero-posteriorly corresponding to the medial and antero-posteriorbowing of the medullary cavity of the femur, said member being taperedfrom a greater size at the upper end thereof for a substantial portionof the length of the same, corresponding to the tapering of themedullary cavity of the femur, a pointed plug held by the lower end ofsaid member, a plug in the upper end of said member, a pin held by thelast mentioned plug, and a ball held by the upper end of said pin, theoutermost portions of said tubular member comprising a plurality ofgenerally parallel, relatively narrow and circumferentially displacedsurfaces for gripping the walls of the medullary cavity.

JOHN T. KANE.

REFERENCES CITED The following references are of record in the file ofthis patent:

UNITED STATES PATENTS OTHER REFERENCES Lenclouage medullaire desfractures diaphysaires, by Robert Soeur, in Scalpel, No. '15, August1944, published by the Surgical Service of the Hospital St. Pierre,Brussels, Belgium.

